Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors

BackgroundGI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial.ObjectiveThe aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs.DesignProspective case series.SettingAcademic medical center.PatientsEight patients with submucosal gastric tumors <2 cm in diameter suspected to be GISTs.InterventionsEndoscopic ligation and resection.Main Outcome MeasurementsClinical/technical feasibility, success, and adverse events.ResultsSeven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred.LimitationsSmall number of patients (n = 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign.ConclusionsEndoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method.